Intra-abdominal bleeding caused by amyloid transthyretin amyloidosis in the gastrointestinal tract: a case report

Yumoto, Shinsei; Doi, Koichi; Higashi, Taishi; Shimao, Yoshiya; Ueda, Mitsuharu; Ishihara, Akira; Adachi, Yuki; Ishiodori, Hiroyuki; Honda, Shoji; Baba, Hideo

doi:10.1007/s12328-021-01551-y

Cited by 2 publications

(1 citation statement)

References 30 publications

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“…Some case reports appear to confirm these findings, such as the case of a 75-year-old man hospitalised for heart failure who presented with periorbital ecchymosis (raccoon eye) and shoulder swelling (pad sign) who was eventually diagnosed with ATTRwt-CA by cardiac biopsy [39]; and the case of a 69-year-old woman with periorbital purpura who, after echocardiography, was diagnosed with ATTRv-CA with the genetic variant Thr80Ala [40]. There have also been reports in the literature of gastrointestinal bleeding, obstruction, or perforation as a possible result of amyloid deposition in the gastrointestinal mucosa; a 79-year-old man with intra-abdominal haemorrhage underwent emergency partial resection of the transverse colon and the postoperative pathological examination of tissue samples led to the diagnosis of ATTR amyloidosis [41]. Urinary tract bleeding was reported in a patient with severe haematuria who was diagnosed with ATTRwt by cystoscopy and bladder biopsy.…”

Section: Spontaneous Bleeding Manifestations: Case Reportsmentioning

confidence: 99%

Thromboembolic and Bleeding Events in Transthyretin Amyloidosis and Coagulation System Abnormalities: A Review

Napolitano,

De Michieli,

Sinigiani

et al. 2023

JCM

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Transthyretin amyloidosis (ATTR) is a group of diseases caused by the deposition of insoluble fibrils derived from misfolded transthyretin, which compromises the structure and function of various organs, including the heart. Thromboembolic events and increased bleeding risk are among the most important complications of ATTR, though the underlying mechanisms are not yet fully understood. Transthyretin plays a complex role in the coagulation cascade, contributing to the activation and regulation of the coagulation and fibrinolytic systems. The prevalence of atrial fibrillation, cardiac mechanical dysfunction, and atrial myopathy in patients with ATTR may contribute to thrombosis, though such events may also occur in patients with a normal sinus rhythm and rarely in properly anticoagulated patients. Haemorrhagic events are modest and mainly linked to perivascular amyloid deposits with consequent capillary fragility and coagulation anomalies, such as labile international-normalised ratio during anticoagulant therapy. Therefore, it is paramount to carefully stratify the thrombotic and haemorrhagic risks, especially when initiating anticoagulant therapy. Our review aims to ascertain the prevalence of thromboembolic and haemorrhagic events in ATTR and identify potential risk factors and predictors and their impact on antithrombotic therapy.

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Section: Spontaneous Bleeding Manifestations: Case Reportsmentioning

confidence: 99%

Thromboembolic and Bleeding Events in Transthyretin Amyloidosis and Coagulation System Abnormalities: A Review

Napolitano,

De Michieli,

Sinigiani

et al. 2023

JCM

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Surgical strategies for localized colorectal amyloidosis

Tahara¹,

Kohyama²,

Nakamitsu³

et al. 2023

surg case rep

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Background Localized colorectal amyloidosis has a good prognosis, but cases involving bleeding or perforation may require surgery. However, there are few case reports discussing the differences in the surgical strategy between the segmental and pan-colon types. Case presentation A 69-year-old woman with a history of abdominal pain and melena was diagnosed with amyloidosis localized in the sigmoid colon by colonoscopy. Since preoperative imaging and intraoperative findings could not rule out malignancy, we performed laparoscopic sigmoid colectomy with lymph-node dissection. Histopathological examination and immunohistochemical staining revealed a diagnosis of AL amyloidosis (λ type). We diagnosed localized segmental gastrointestinal amyloidosis, because there was no amyloid protein in the margins, and the tumor was localized. There were no malignant findings. Conclusions Unlike systemic amyloidosis, localized amyloidosis has a favorable prognosis. Localized colorectal amyloidosis can be classified into the segmental type, in which amyloid protein is deposited locally, and the pan-colon type, in which amyloid protein is deposited extensively in the colon. Amyloid protein causes ischemia due to vascular deposition, weakening of the intestinal wall due to muscle layer deposition, and decreased peristalsis due to nerve plexus deposition. No amyloid protein should remain outside the resection area. The pan-colon type is often reported to cause complications such as anastomotic leakage, and primary anastomosis should be avoided. On the other hand, if there is no contamination or tumor remnants in the margin, the segmental type may be considered for primary anastomosis.

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Intra-abdominal bleeding caused by amyloid transthyretin amyloidosis in the gastrointestinal tract: a case report

Cited by 2 publications

References 30 publications

Thromboembolic and Bleeding Events in Transthyretin Amyloidosis and Coagulation System Abnormalities: A Review

Thromboembolic and Bleeding Events in Transthyretin Amyloidosis and Coagulation System Abnormalities: A Review

Surgical strategies for localized colorectal amyloidosis

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